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Eur J Vasc Endovasc Surg. 2018 Aug;56(2):264-270. doi: 10.1016/j.ejvs.2018.02.005. Epub 2018 Mar 23.

Myocardial Injury is More Common than Deep Venous Thrombosis after Vascular Surgery and is Associated with a High One Year Mortality Risk.

Author information

1
Department of Intensive Care and Peri-operative Medicine, Jagiellonian University Medical College, Kraków, Poland; Department of Medicine, Jagiellonian University Medical College, Kraków, Poland. Electronic address: gorkajacek1@gmail.com.
2
Department of Intensive Care and Peri-operative Medicine, Jagiellonian University Medical College, Kraków, Poland.
3
Department of Medicine, Jagiellonian University Medical College, Kraków, Poland; Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland.
4
Vascular Surgery Department, Merciful Brothers St. John Grande Hospital, Kraków, Poland.
5
Department of Medicine, Jagiellonian University Medical College, Kraków, Poland.
6
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
7
Department of Anaesthesia and Perioperative Medicine, University of Cape Town and New Groote Schuur Hospital, Cape Town, South Africa.
8
Department of Intensive Care and Peri-operative Medicine, Jagiellonian University Medical College, Kraków, Poland; Department of Medicine, Jagiellonian University Medical College, Kraków, Poland.

Abstract

OBJECTIVE/BACKGROUND:

Venous thromboembolism (VTE) has been considered the dominant major life threatening vascular complication after non-cardiac surgery, but recent studies have shifted the emphasis toward myocardial injury after non-cardiac surgery (MINS) as a common adverse event in the peri-operative setting. The aim of the present study was to compare the incidence and influence on mortality of two dominant venous and arterial events in the peri-operative period by prospectively screening a consecutive cohort of patients undergoing vascular surgery.

METHODS:

This was a sub-study of Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION), the main objective of which was to evaluate major peri-operative complications after non-cardiac surgery. Patients undergoing vascular surgery had their blood collected to measure the Roche fifth generation high sensitivity troponin T (hsTnT) assay before and four times after surgery (6-12 h post-operatively, on the first, second, and third day following the procedure). MINS was defined as an elevated post-operative hsTnT ≥65 ng/L or an hsTnT ≥20 to <65 ng/L with an absolute change of ≥5 ng/L that was judged to be due to ischaemia. All patients underwent ultrasound venous compression testing for deep vein thrombosis (DVT) before, 4, and 7 days after surgery and follow-up was performed by telephone 30 days and 1 year after surgery.

RESULTS:

In total, 164 consecutive patients were included in this sub-study. MINS was diagnosed in 39 patients (23.8%) and DVT in four patients (2.4%). The 1 year mortality was higher in MINS (9/39 [23.1%]) than non-MINS patients (9/125 [7.2%]; p = .006). None of the patients who developed DVT died in the first year after surgery.

CONCLUSION:

MINS is a common complication after vascular surgery. It occurs more frequently than DVT and is associated with high 1 year mortality.

KEYWORDS:

Myocardial ischaemia; Prognosis; Vascular surgical procedures; Venous thromboembolism

PMID:
29580830
DOI:
10.1016/j.ejvs.2018.02.005
[Indexed for MEDLINE]
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